Colonoscopy
Normal Video Colonoscopy.

Normal Video Colonoscopy

Showing characteristic triangular folds of the transverse colon.

With the patient in left lateral decubitus position, a long, flexible,lighted viewing tube (colonoscope) is inserted through the rectuminto the colon. The scope is advanced and maneuvered while thelumen and walls of the colon are visualized by projections onto amonitor screen. The colonoscope has channels through whichinstruments can be passed in order to perform biopsies, removepolyps, or cauterize bleeding. Air, water, and suction can beapplied to help provide a clearer visual field for inspection.

For more endoscopic details download the video clip by
clicking on the endoscopic image.
All endoscopic images shown in this Atlas contain video
clips.

 

Colonoscopy

Video Colonoscopy

This picture as well as the video clip display a fragment of a colonoscopy.

The goal for a complete examination is to reach the cecum and, insome cases, the terminal ileum. Landmarks that may help todetermine if this has been achieved include visualization of theappendiceal orifice and the ileocecal valve. Transilluminationabove the right inguinal canal also suggests cecal intubation.

 

Colonoscopy

Video Endoscopic Sequence 1 of 3.

Colonoscopy with The narrow band imaging (NBI)

The narrow band imaging (NBI) system consists of a sequential electronic endoscope system and a source of light equipped with new narrow band filters, yielding very clear images of microvessels on mucosal surfaces.

 

Colonoscopy

Video Endoscopic Sequence 2 of 3.

A newly developed narrow-band imaging (NBI) system, which uses modified optical filters, can yield clear images of microvessels and surface structure in gastric and colonic diseases.

 

Colonoscopy

Video Endoscopic Sequence 3 of 3.

NBI displays enhanced images of capillaries in the mucosal surface and detailed mucosal texture by irradiating two narrow wave bands (390–445 nm/530–550 nm) which are strongly absorbed by circulating hemoglobin.
If signal processing is performed using a pseudo-narrow band image, the state of mucosa tissues and observation conditions influence the results and good effects cannot be obtained. However, with NBI, the wavelength of the irradiating light itself is altered, and capillaries in the mucosal surface and detailed mucosal texture can thus be processed effectively and stably.

 

El Ciego

Video Endoscopic Sequence 1 of 2.

Ileocecal Valve

Is a sphincter muscle valve that separates the small intestine and the large intestine. Its critical function is to limit the reflux of colonic contents into the ileum Approximately two litres of fluid enters the colon daily through the ileocecal valve.

During colonoscopy, the ileocecal valve is used, along with the appendiceal orifice, in the identification of the cecum. This is important as it indicates that a complete colonoscopy has been performed. The ileocecal valve is typically located on the last fold before entry into the cecum, and can be located from the direction of curvature of the appendiceal orifice, in what is known as the bow and arrow sign

Intubation of the ileocecal valve is typically performed in colonoscopy to evaluate the distal, or lowest part of the ileum. Small bowel endoscopy can also be performed by double-balloon enteroscopy through intubation of the ileocecal valve.

 

 

Agujero del apendice

Video Endoscopic Sequence 2 of 2.

Terminal ileum

 For the diagnosis of the diseases which affect the terminal ileum, the colonoscopy allows macroscopic evaluation and the performing of biopsies. Studies with criteria for the endoscopic and histological characterization of this segment are scarce and there are still some doubts about the need of biopsies in patients with normal ileoscopy. 

Mercedes Benz’ sign

Video Endoscopic Sequence 1 of 2.

‘Mercedes Benz’ sign

The cecum is usually located in the right iliac fossa. In the pole of the cecum, there is often the appearance of fusion of the three teniae coli around the appendix, giving rise to the tri-radiate fold (‘Mercedes Benz’ sign), but the anatomy can be variable. The most reliable landmarks of the cecum are the appendiceal orifice and ileocecal valve. The appendiceal orifice is usually an unimpressive slit, often crescentic in shape. The ileocecal valve is made up of the superior and inferior lips (usually not seen en face) and is the gateway leading into the terminal ileum. It is located on the prominent ileocecal fold encircling the cecum, between 3 and 5 cm distal to the cecal pole.

Mercedes Benz’ sign

Video Endoscopic Sequence 2 of 2.

‘Mercedes Benz’ sign

Normal Appendiceal Orifice, Cecum and Ileocecal Valve
Complete colonoscopy for cancer screening requires cecal intubation. Failure to reach and examine the cecum may result in missed right colon pathology.

 

Colonoscopy

The Cecum.

Normal view of the ileocecal valve is observed. The ileocecal valve is the opening between the large and small intestines. It often gets stuck shut or open. It needs to be free to open or shut at appropriate times. Palm down to test for stuck shut, palm up for stuck open. To correct stuck shut valve: apply pressure down and out over valve. To correct stuck open valve: push in and up over area. The location is about 2 inches below the appendix.

 

Colonoscopy

The Cecum.

Cecum and Ileocecal valve, normal view looking into the cecum. Characteristic land marks of the appendiceal orifice and ileocecal valve (upper left). 

 

Colonoscopy

Cecum with appendiceal orifice.

View of the “crows´s foot” appearance of the haustral folds. Appendiceal opening may be found in the cecum in up to 20% of cases. Characteristic appearance is a dimple-like depression about 5mm in diameter. When there has been previous surgery, the mouth of the appendix may be eroded, giving the appendiceal stump a polypoid appearance.

 

Colonoscopy

Endoscopic Sequence 1 of 4.

This four images and videos displays a full colonoscopy ( withdrawal) from the cecum to the rectum. The image displays the orifice of the appendix that is one of the three parameters of the cecum. Others parameters are: the ileocecal valve and the three taenia coli converge at the apex of the cecum, usually with the appendiceal orifice at the point of convergence. The video clip displays the colonoscopy from the cecum to ascending colon.

 

Colonoscopy

Video Endoscopic Sequence 2 of 4.

Prominent bluish liver shadow due to adjacent liver. The video clip displays a video colonoscopy from the ascending colon to hepatic angle and transverse colon. This colonoscopy is the sequence of the above.

 

Colonoscopy

Video Endoscopic Sequence 3 of 4.

The video clip exhibit a video colonoscopy from the transverse colon, spleen flexure with prominent bluish spleen shadow, the descending and sigmoid.

 

Colonoscopy

Video Endoscopic Sequence 4 of 4.

The rectum seen in retroflexed maneuver.

The video clip display a colonoscopy that is the sequence of the above, from the sigmoid, rectal valves and the anus display a retroflexed maneuver to visualize the rectum, prior to withdrawal and completion of video colonoscopy.

 

Colonoscopy

The Cecum.

Ileocecal valve and the confluence of the tree taenias. See the video by clicking on the image, you can appreciate the ileocecal valve from which a valve emerges air bubble.
The ileocecal valve is where the small intestine empties into the large intestine and there is a valve behind the fold that we are looking at. You can see that this fold is thicker than the fold on the bottom of the screen where there is no such valve. In the distance, we see the end of the colon, which is otherwise known as the cecum. This is completely normal.

 

Colonoscopy

Splenic Flexure.

The video clip shows the peristalsis over the spleen.

 

Colonoscopy

Splecnic Flexure.

A prominent spleen is observed.

 

Colonoscopy

Transverse Colon.

Normal Video Colonoscopy showing characteristic triangular folds of the transverse colon.

 


 

Colonoscopy

Sigmoid in retrofled view.

Rcto-Sigmoid seen en retroflexed maneuver.

The video clip displays the sigmoid and rectum in retroflexed maneuver observing the rectal valves Retroflexed maneuver offers additional views of the colon which increases the sensitivity of the procedure in some cases.

 

Colonoscopy

Cecum: Appendiceal Orifice.

This is a photograph of an inverted appendix which an inexperienced endoscopist could mistakenly take for a polyp.
Attempts to remove this 'polyp' could potentially cause perforation.

 

Magnifying Colonoscopy

Magnifying Colonoscopy

This image displays a tiny eritematous lesion of the rectum seen with magnifying colonoscope, to appreciate this lesion you should see the video clip.

 

Magnifying Colonoscopy

Magnifying Colonoscopy.

In this image and the video clip a rectal artery is seen using a magnifying colonoscope.

 

Cecum: Lumen of Appendix

Cecum: Lumen of Appendix

This video clip shows part of the appendiceal lumen

 

 

 

 

 

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